Early outcomes of transatrial mitral valve replacement in severe mitral annular calcification

• Authors: Yuji Kawano, Harvard Medical School; Paige Newell, Harvard Medical School; Morgan Harloff, Harvard Medical School; Sameer Hirji, Harvard Medical School; Edward Percy, The University of British Columbia; Pinak Shah, Harvard Medical School; Tsuyoshi Kaneko, Harvard Medical School
• Journal Title: JTCVS Techniques
• Volume: Volume 9
• Publisher: Elsevier | 2021-10-01, Pages 49-56
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.xjtc.2021.06.015
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: CT, computed tomography; EOA, effective orifice area; LVOT, left ventricular outflow tract; MAC, mitral annular calcification; MVR, mitral valve replacement; PVL, paravalvular leak; TAVR, transcatheter aortic valve replacement; THV, transcatheter heart valve; TMVR, transcatheter mitral valve replacement; mitral annular calcification; mitral valve replacement; transatrial; transcatheter

Abstract

Objective: Mitral valve replacement (MVR) in the setting of severe mitral annular calcification is a technically challenging operation with increased morbidity and mortality. Transseptal/apical transcatheter MVR (TMVR) in mitral annular calcification has emerged as an option for these cases, although may not be feasible due to anatomical reasons. Transatrial TMVR is a potential treatment option for this subgroup of patients. Methods: Patients who underwent transatrial TMVR between June 2018 and November 2020 at a single institution were included. Patients were selected by a structural heart team based on their surgical risk, pattern of mitral annular calcification, risk of valve migration, left ventricular outflow obstruction, and paravalvular leak. Results: A total of 11 patients underwent transatrial TMVR. Mean patient age was 74.2 years and mean Society of Thoracic Surgeons predicted risk of mortality score was 9.1%. All patients had the presence of both mitral stenosis and regurgitation—dominant etiology—was mitral stenosis in 81.2%, and mitral regurgitation in 18.8%. Among patients, 54.5% had a concomitant cardiac procedure. There was no in-hospital or 30-day mortality. Technical success defined by the Mitral Valve Academic Research Consortium was achieved in 90.9% of patients. Postoperative paravalvular leak was mild or less in all patients. Conclusions: In this series, transatrial TMVR was shown to be a safe and effective treatment option for patients who are high risk for surgical MVR and should be in surgeons' armamentarium in the treatment of this high-risk patient population. Dissemination of safe technique will be critical in the successful conduct of this surgery.